NYAPRS Note: Here’s a NYS Medicaid Reform 101 summary aimed at providing a simple backdrop to understanding where we are with the move to Value Based Payments.

1. In April 2014, NYS reached a waiver agreement with CMS (the federal Medicaid/Medicare agency) that allowed the state to reinvest $8 billion in federal savings generated by NYS Medicaid reforms.

2. $6.42 billion of that amount has been dedicated to advancing the state’s Delivery System Reform Incentive Payment (DSRIP) program, which is being used to support 25 regional collaborations (Performing Provider Systems) across the healthcare and social services spectrum to reform and integrate their efforts to both improve care and to achieve a 25% reduction in avoidable hospital use over five years.
See https://www.health.ny.gov/health_care/medicaid/redesign/dsrip/pps_map/index.htm to see how one or more PPSs are operating in your area.

3. CMS and New York also agreed that the state would submit a multi-year roadmap to move how healthcare services are paid for from a fee per visit system to one based on Value Based Payments that will pay according to whether and how folks get better.

By the 5th and final year of the DSRIP program (2019), all managed care organizations must employ value based payment systems for at least 80 – 90% of their provider payments.

4. The state convened a VBP Work Group and 5 subcommittee to help design how VBP will be implemented across New York, as regards Medicaid, Medicare and eventually commercial insurance programs. The workgroup membership can be found at https://www.health.ny.gov/health_care/medicaid/redesign/dsrip/vbp_workgroup.htm

Here are the links to the subcommittees, including a number of reports and presentations the group has developed and shaped.

• Technical Design I

• Technical Design II

• Regulatory Impact

• Social Determinants of Health and Community Based Organizations (CBOs)

• Advocacy and Engagement

NYAPRS representatives sit on every group and Harvey Rosenthal is co-chair of the Advocacy Engagement subcommittee and also serves on the ‘mothership’ Work Group.

5. Over the past few weeks, the state has put up 2 minute videos aimed at providing a simple explanation about what VBP entails.

https://www.youtube.com/watch?v=9D4M-QsaNfM English version

https://www.youtube.com/watch?v=Aq4sJq8Xj4o Spanish version

6. Next Steps: The Technical Design I and Advocacy and Engagement groups have completed their work. The Regulatory Impact group will wrap up today, Technical Design II will finish its work this Wednesday and the Social Determinants and Community Based Organizations group will wrap up on next Wednesday.

The Steering Committee will meet next Thursday, to consider all the groups’ recommendations. Where consensus on a recommendation can’t be reached, the state will make the final determination.